Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 111560 | NC |
NPI | 1184774390 |
---|---|
Provider Name | Mrs. Christy Anne Fugo |
First Address | Greenville, NC 27858-6097 |
Second Address | Greenville, NC 27834-2818 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |